POS0482 PATIENT CENTERED- TREAT TO TARGET- DISEASE SPECIFIC GUIDELINES: EXPANDING THE PERTINENCE OF CLINICAL PRACTICE GUIDELINES TO PATIENTS
Authors: Y. El Miedany, M. H. Abu-Zaid, S. A. Mahran, M. Elgaafary, M. Elwy, W. Hassan, S. Saber, S. A. A. Tabra, W. Elwakil
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Although all patients present unique biopsychosocial contexts, the care of inflammatory arthritis patients is particularly complicated by the interaction of multiple factors. Advocates of patient- centered care identify that the best way to manage complex patients is through comprehensive treatment strategies that can adapt to the nuances of individual contexts. Recently published disease specific, patient centered national clinical guidelines for inflammatory arthritis [1] represent a model of care that can be fit for standard, disease-oriented patients' management. <h3>Objectives</h3> To assess for the outcomes of indiscriminately implementing individual, disease-specific treatment strategies in standard clinical practice for the treatment of inflammatory arthritis and its impact on the disease activity measures as well as patient reported outcomes. <h3>Methods</h3> A 12-month multicenter, randomized study compared standard care with patient-centered, Treat to Target (T2T) management of inflammatory arthritis. All patients completed patient reported outcome measures [2]. Regular appointments were delivered by specially trained rheumatologists who kept a record of the clinical assessments, medication titration, patient reported outcomes, self-management, psychosocial support and motivation score. The primary outcome was 12-month remission assessed using the Disease Activity Score for 28 joints using ESR (DAS28-ESR). Secondary outcomes included fatigue, functional disability, quality of life and motivation levels. <h3>Results</h3> 297 rheumatoid arthritis patients were screened and randomized (149 Treat to Target management; 148 standard care); 269 (90.6%) patients had their 12-month outcomes completed. Patient centered treat to target management increased DAS28-ESR 12-month remissions compared to standard care (43% vs 22%, p = 0.004). Patient centered T2T management also significantly increased prevalence of those who achieved DAS28-ESR low disease activity scores. (38% vs 23%, p = 0.005). In addition, it substantially improved patients' functional ability (0.4 + 0.2 Vs 1.1 + 0.3, p&lt; 0.01), quality of life (0.6 + 0.2 Vs 1.2 + 0.5, p&lt; 0.01), reduced fatigue (4.2 + 1.3 Vs 6.8 + 1.6, p&lt; 0.01). Motivation score was higher in the T2T cohort (8.4 + 1.3 Vs 5.7 + 2.1, p&lt; 0.05). There was no evidence that serious adverse events (patient centered T2T management =14 vs standard care =12) or other adverse events (112 vs 106) differed in both groups. <h3>Conclusion</h3> More patients achieve the treatment target of remissions or low disease activity status. There were greater improvements in patient reported outcomes, functional ability, fatigue as well as motivation. In the meantime, there were no more harms. Patient centered T2T clinical guidelines are able to provide condition-specific guidance on how one would optimally manage a disease tailored to the individual patient's requirements. <h3>References</h3> [1]El Miedany Y. et al, Egyptian guidelines for the treatment of Rheumatoid Arthritis — 2022 update. Egypt Rheumatol Rehabil 2022; 49: 56. [2]El Miedany Y. et al. development and validation of a questionnaire for inflammatory arthritis. Clin Exp Rheumatol 2010; 28(5):734-44. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.